THE LIMITED VALUE OF HYSTEROSALPINGOGRAPHY IN ASSESSING TUBAL STATUS AND FERTILITY POTENTIAL

Design: To determine whether the diagnostic accuracy and prognostic va lue of hysterosalpingography (HSG) could be improved if routine spot f ilms were replaced by an on-line recorded gynecoradiologic study. Sett ing: Medical school-affiliated private infertility center. Patients: I n 1992, a review of 152 infertile women with infertility who demonstra ted a normal HSG, by standard criteria of spot film evaluation, in 117 (77%). They were further investigated by gynecoradiologic study if th e HSG revealed asymmetrical tubal filling, an increased perfusion pres sure, and/or evidence for abnormal tubal spill. In 1993, 47 women with normal HSG by spot film criteria underwent bilateral selective salpin gography and were subdivided into those with normal (group I, n = 23) and abnormal (group II, n = 24) tubal perfusion pressures. Interventio n: Patients in both study groups then were treated for their infertili ty independently of pressure perfusion measurements. Main Outcome Meas ure: Clinical pregnancy rates (PRs) over the ensuing 6 to 10 months. R esults: Among 117 women with apparently normal spot film HSG, 64 (55%) demonstrated asymmetrical tubal filling, 32 (27%) demonstrated abnorm al spillage into the peritoneal cavity, and 55 (47%) demonstrated abno rmally elevated injection pressures. Among 98 women who underwent bila teral selective salpingography, 43 (44%) demonstrated bilaterally norm al tubal perfusion pressures and 55 (56%) showed an abnormally elevate d pressure in at least one oviduct. Of 47 women that were followed pro spectively in 1993, patients with normal perfusion pressure (group I) demonstrated a significantly higher PR than women with elevated tubal pressure (group II) from 2 months and on after the procedure. Conclusi ons: Routine spot film HSG is of limited value in assessing tubal stat us beyond the determination of tubal patency. Especially with regard t o fertility potential, HSG should be replaced by gynecoradiologic stud y.